采用直接观察短程治疗（DOTS）策略的儿童结核性胸膜炎的临床特征及治疗结果

Clinical profile and treatment outcome of tubercular pleurisy in pediatric age group using DOTS strategy.

作者信息

Sharma Sangeeta, Sarin Rohit, Khalid U K, Singla N, Sharma P P, Behera D

机构信息

LRS Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi - 110 030.

出版信息

Indian J Tuberc. 2009 Oct;56(4):191-200.

PMID:20469730

Abstract

BACKGROUND

A significant proportion of global tuberculosis (TB) caseload is contributed by children. Management of pediatric TB especially EPTB is challenging. The present study was designed to study demographic, clinical profile and treatment outcome of DOTS strategy for pediatric tubercular pleurisy.

AIM

To study the efficacy of DOTS strategy.

METHODS

Retrospective analysis of 106 TB pleurisy children treated with DOTS.

RESULTS

Mean age was 10.8 years (median age 12.2 years) with more females (51.9%) than males (48.1%) chi1(2) = 0.15; P = 0.698 (NS). In the age group of 0-5, 6-10 and 11-14 years, there were 15.1%, 30.2% and 54.7% patients respectively. Fever was the commonest symptom (98.1%) followed by cough (77.4%) and chest pain (55.7%). History of contact could be elicited only in 2/3rd of cases unilateral effusion (61.3%) was commonest, followed by empyema (22.6%), massive effusion and broncho-pleural fistula each in 13.2% cases respectively. Bilateral effusion was seen in 3.8% cases only. Conventional methods (mantoux, radiograph, ultrasound, pleural aspiration) and minimal invasive surgical techniques, percutaneous pleural biopsy were done to arrive at the diagnosis. Diagnosis was made by X-ray Chest in 92.5%, exudative pleural fluid (100%) predominantly lymphocytic in 85.8%, positive AFB smear and culture in 4.7 and 5.7% cases respectively. Category I, II and III was started on 35.9%, 2.8% and 61.3% patients respectively. Overall treatment completion rate was 94.3%, 4.7% default rate, 0.9% failure rate and no deaths.

CONCLUSION

The study confirms early detection by simple tests and ensuring complete treatment using DOTS strategy.

摘要

背景

全球相当一部分结核病（TB）病例由儿童构成。儿童结核病尤其是肺外结核的管理具有挑战性。本研究旨在探讨直接观察治疗短程化疗（DOTS）策略用于儿童结核性胸膜炎的人口统计学、临床特征及治疗结果。

目的

研究DOTS策略的疗效。

方法

对106例接受DOTS治疗的结核性胸膜炎患儿进行回顾性分析。

结果

平均年龄为10.8岁（中位年龄12.2岁），女性（51.9%）多于男性（48.1%），χ1(2)=0.15；P=0.698（无显著性差异）。在0-5岁、6-10岁和11-14岁年龄组中，患者分别占15.1%、30.2%和54.7%。发热是最常见的症状（98.1%），其次是咳嗽（77.4%）和胸痛（55.7%）。仅在2/3的病例中能引出接触史。单侧胸腔积液最常见（61.3%），其次是脓胸（22.6%），大量胸腔积液和支气管胸膜瘘各占13.2%。双侧胸腔积液仅见于3.8%的病例。采用传统方法（结核菌素试验、X线片、超声、胸腔穿刺）及微创外科技术经皮胸膜活检以明确诊断。92.5%的病例通过胸部X线诊断，100%的渗出性胸腔积液以淋巴细胞为主，4.7%的病例抗酸杆菌涂片阳性，5.7%的病例培养阳性。分别有35.9%、2.8%和61.3%的患者开始接受I类、II类和III类治疗。总体治疗完成率为94.3%，失访率为4.7%，失败率为0.9%，无死亡病例。